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388 Sepsis Fun Facts: A Simple Way to Increase Sepsis Bundle Compliance
Research Forum Abstracts
388
Sepsis Fun Facts: A Simple Way to Increase Sepsis Bundle Compliance
Leon LN II/University of Central Florida/ HCA GME Emergency Medicine Residency Program of Greater Orlando, Kissimmee, FL
Study Objectives: To design a quality improvement project to improve sepsis bundle compliance in our emergency department. Methods: This was a before and after study. Historical data on sepsis bundle compliance was obtained from our quality officer. In our institution, the sepsis bundle consists of 1) blood cultures before antibiotics, 2) antibiotics within 1 hr of recognition, 3) serum lactate level at presentation with 3hr repeat if elevated >2, and 4) crystalloid fluid resuscitation of 30cc/kg. Start date was determined by our department’s QI launch; we collected data for 30 consecutive days and compared sepsis bundle compliance rates before and after the intervention. Descriptive statistics were compiled, and the z-test for proportions was used to calculate statistical significance. The intervention was two-fold: 1) a bright yellow card with sepsis criteria listed was posted on all ED workstation computers; and 2) daily email blast for 1 month with “sepsis fun facts.” These email blasts were short pearls that highlighted the importance of recognizing and treating sepsis. Results: The sepsis bundle compliance rates in the month prior to the intervention was 38%. In the month during the targeted intervention, the compliance rate increased to 56%. There was a statistically significant increase in bundle compliance rates during the intervention (P¼0.0399). We also administered a survey to the ED attendings and residents following the completion of the study to assess whether they perceived our intervention as helping them increase compliance with ordering the sepsis bundle. The response rate was 94%. To the question “Did you feel the SEPSIS cards placed on the workstations make you more likely to consider sepsis earlier in patients under your care in the emergency department?” 70% answered agree or strongly agree. To the question “Were you more likely to order the SEPSIS bundle after receiving the daily Sepsis “Fun Facts”?” 29% were neutral while 59% answered agree or strongly agree. Finally, to the question “Did you feel the Sepsis Cards and “Fun Facts” help you improve the care of Septic patients in the emergency department?” 76% answered agree or strongly agree. Conclusions: Simple interventions such as sepsis criteria reminders and email blasts highlighting the importance of treating and recognizing sepsis can improve compliance with sepsis bundle ordering within the emergency department. A post-intervention survey suggests that such reminders do influence emergency physicians and increase their awareness of sepsis.
389
My Visit Board: Improving Patient Understanding of Emergency Department Care
Funk E, Kummer T, Friedrich C, Lohse C, Heaton H/Mayo Clinic, Rochester, MN
Study Objectives: Improve the patient experience in the emergency department (ED) by providing information identifying the role of the various emergency department staff members, communicating expected wait times, and providing targeted health information.
S152 Annals of Emergency Medicine
Methods: A rotating slide deck, termed the My Visit Board (MVB), was created and displayed on a screen in each ED patient room. The slide content was created by a multidisciplinary group including physicians, residents and nurses, with assistance from the Department of Patient Education. Survey data was collected both before and after implementation of the intervention. Patients were asked to a 3-question paper survey, to assess the patient’s self-reported understanding using a Likert scale. Patients were eligible to receive a survey if they had a final disposition entered in the electronic medical record. Exclusion criteria were an inability to understand English, intoxication, and cognitive inability to a survey as judged by their ED provider or nurse. A convenience sample patients were surveyed both before and after the intervention. Survey data was also collected from ED staff in order to assess any negative impact on clinicians. All nurses, residents, and attending physicians in the ED were eligible to participate. Surveying was completed using a third party online survey business. The survey data was compared using Wilcoxon signed-rank tests. Results: Thirty-seven patient surveys were collected before and after implementation. Results show significant improvement in how well patients knew the members of their care team (6.57 to 7.84; p<0.018). Patients also were aware of information on general health topics more frequently after the intervention (5.22 to 6.89; p<0.016). There was no significant difference in patient understanding of wait times (6.05 to 6.43; p<0.560). Providers felt that their patients had improved understanding of wait times (3.55 to 5.20; p<0.001) but there was no significant decrease in the level of patient/provider conflict (5.99 to 5.75; p<0.430). Providers felt that overall, the My Visit Board significantly improved the patient/provider relationship (3.39 to 3.62; p <0.015). Conclusions: This data reveals that the My Visit Board improved patient understanding of the care team and resulted in better communication of general health topics. Providers indicated that there was a positive impact on the patient-provider relationship. Use of a slide deck in ED exam rooms to convey information to patients is a viable communication tool. Further work is needed to improve communication of wait times and identify other topics that could be shared with patients via this medium.
390
Pilot Study to Test and Refine an Emergency Department Trigger Tool
Griffey RT, Schneider RM, Todorov AA/Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO; Ryan Schneider, Saint Louis, MO; Washington University School of Medicine, St. Louis, MO
Study Objectives: Quality and safety review methods used in many EDs are decades old, porous and inefficient for identifying adverse events (AEs). Trigger Tools (TTs) popularized by the Institute for Healthcare Improvement, use 2-level reviews: a 1st level (L1) nurse review searching for the presence of triggers (thought to increase the likelihood of an AE) and if present, in-depth review for an AE, followed by a 2nd level physician review (L2) for putative AEs. TTs have been developed for a variety of clinical specialties. Recently, we developed an ED Trigger tool (EDTT) using a multidisciplinary, multicenter modified delphi consensus process to generate an initial list of 104 candidate triggers specific to the ED, including 46 strong candidates. We present preliminary data to test and refine the EDTT in which we: 1) specify the full list of candidate triggers for a computerized query (to ultimately eliminate this part of the 1st level review) and 2) perform manual record reviews applying a rigorous quantitative approach for identifying triggers associated with AEs. Methods: This study was performed at an urban academic emergency department with over 95,000 annual visits, using data from 10/1/2015 - 10/31/ 2016. We implemented the triggers from the EDTT in computerized queries, mapping individual triggers to structured fields in electronic medical records (EMR). In parallel, we provided extensive training for three RNs to act as first-level reviewers, and conducted dual L1 review and L2 review for all records (not just those with AEs identified on L1 review). AEs were assigned severity ratings using the National Coordinating Council Medication Error Reporting Program Index and to one of 4 AE categories (medication, medical care, procedural, other). Identification of triggers on manual review were compared to results of the query. In this derivation phase, we selected visits that were enriched in number and scope of triggers. We calculated interrater reliability for each trigger and present proportions with CIs and present descriptive and univariate data for patient
Volume 70, no. 4s : October 2017
388
Sepsis Fun Facts: A Simple Way to Increase Sepsis Bundle Compliance
Leon LN II/University of Central Florida/ HCA GME Emergency Medicine Residency Program of Greater Orlando, Kissimmee, FL
Study Objectives: To design a quality improvement project to improve sepsis bundle compliance in our emergency department. Methods: This was a before and after study. Historical data on sepsis bundle compliance was obtained from our quality officer. In our institution, the sepsis bundle consists of 1) blood cultures before antibiotics, 2) antibiotics within 1 hr of recognition, 3) serum lactate level at presentation with 3hr repeat if elevated >2, and 4) crystalloid fluid resuscitation of 30cc/kg. Start date was determined by our department’s QI launch; we collected data for 30 consecutive days and compared sepsis bundle compliance rates before and after the intervention. Descriptive statistics were compiled, and the z-test for proportions was used to calculate statistical significance. The intervention was two-fold: 1) a bright yellow card with sepsis criteria listed was posted on all ED workstation computers; and 2) daily email blast for 1 month with “sepsis fun facts.” These email blasts were short pearls that highlighted the importance of recognizing and treating sepsis. Results: The sepsis bundle compliance rates in the month prior to the intervention was 38%. In the month during the targeted intervention, the compliance rate increased to 56%. There was a statistically significant increase in bundle compliance rates during the intervention (P¼0.0399). We also administered a survey to the ED attendings and residents following the completion of the study to assess whether they perceived our intervention as helping them increase compliance with ordering the sepsis bundle. The response rate was 94%. To the question “Did you feel the SEPSIS cards placed on the workstations make you more likely to consider sepsis earlier in patients under your care in the emergency department?” 70% answered agree or strongly agree. To the question “Were you more likely to order the SEPSIS bundle after receiving the daily Sepsis “Fun Facts”?” 29% were neutral while 59% answered agree or strongly agree. Finally, to the question “Did you feel the Sepsis Cards and “Fun Facts” help you improve the care of Septic patients in the emergency department?” 76% answered agree or strongly agree. Conclusions: Simple interventions such as sepsis criteria reminders and email blasts highlighting the importance of treating and recognizing sepsis can improve compliance with sepsis bundle ordering within the emergency department. A post-intervention survey suggests that such reminders do influence emergency physicians and increase their awareness of sepsis.
389
My Visit Board: Improving Patient Understanding of Emergency Department Care
Funk E, Kummer T, Friedrich C, Lohse C, Heaton H/Mayo Clinic, Rochester, MN
Study Objectives: Improve the patient experience in the emergency department (ED) by providing information identifying the role of the various emergency department staff members, communicating expected wait times, and providing targeted health information.
S152 Annals of Emergency Medicine
Methods: A rotating slide deck, termed the My Visit Board (MVB), was created and displayed on a screen in each ED patient room. The slide content was created by a multidisciplinary group including physicians, residents and nurses, with assistance from the Department of Patient Education. Survey data was collected both before and after implementation of the intervention. Patients were asked to a 3-question paper survey, to assess the patient’s self-reported understanding using a Likert scale. Patients were eligible to receive a survey if they had a final disposition entered in the electronic medical record. Exclusion criteria were an inability to understand English, intoxication, and cognitive inability to a survey as judged by their ED provider or nurse. A convenience sample patients were surveyed both before and after the intervention. Survey data was also collected from ED staff in order to assess any negative impact on clinicians. All nurses, residents, and attending physicians in the ED were eligible to participate. Surveying was completed using a third party online survey business. The survey data was compared using Wilcoxon signed-rank tests. Results: Thirty-seven patient surveys were collected before and after implementation. Results show significant improvement in how well patients knew the members of their care team (6.57 to 7.84; p<0.018). Patients also were aware of information on general health topics more frequently after the intervention (5.22 to 6.89; p<0.016). There was no significant difference in patient understanding of wait times (6.05 to 6.43; p<0.560). Providers felt that their patients had improved understanding of wait times (3.55 to 5.20; p<0.001) but there was no significant decrease in the level of patient/provider conflict (5.99 to 5.75; p<0.430). Providers felt that overall, the My Visit Board significantly improved the patient/provider relationship (3.39 to 3.62; p <0.015). Conclusions: This data reveals that the My Visit Board improved patient understanding of the care team and resulted in better communication of general health topics. Providers indicated that there was a positive impact on the patient-provider relationship. Use of a slide deck in ED exam rooms to convey information to patients is a viable communication tool. Further work is needed to improve communication of wait times and identify other topics that could be shared with patients via this medium.
390
Pilot Study to Test and Refine an Emergency Department Trigger Tool
Griffey RT, Schneider RM, Todorov AA/Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO; Ryan Schneider, Saint Louis, MO; Washington University School of Medicine, St. Louis, MO
Study Objectives: Quality and safety review methods used in many EDs are decades old, porous and inefficient for identifying adverse events (AEs). Trigger Tools (TTs) popularized by the Institute for Healthcare Improvement, use 2-level reviews: a 1st level (L1) nurse review searching for the presence of triggers (thought to increase the likelihood of an AE) and if present, in-depth review for an AE, followed by a 2nd level physician review (L2) for putative AEs. TTs have been developed for a variety of clinical specialties. Recently, we developed an ED Trigger tool (EDTT) using a multidisciplinary, multicenter modified delphi consensus process to generate an initial list of 104 candidate triggers specific to the ED, including 46 strong candidates. We present preliminary data to test and refine the EDTT in which we: 1) specify the full list of candidate triggers for a computerized query (to ultimately eliminate this part of the 1st level review) and 2) perform manual record reviews applying a rigorous quantitative approach for identifying triggers associated with AEs. Methods: This study was performed at an urban academic emergency department with over 95,000 annual visits, using data from 10/1/2015 - 10/31/ 2016. We implemented the triggers from the EDTT in computerized queries, mapping individual triggers to structured fields in electronic medical records (EMR). In parallel, we provided extensive training for three RNs to act as first-level reviewers, and conducted dual L1 review and L2 review for all records (not just those with AEs identified on L1 review). AEs were assigned severity ratings using the National Coordinating Council Medication Error Reporting Program Index and to one of 4 AE categories (medication, medical care, procedural, other). Identification of triggers on manual review were compared to results of the query. In this derivation phase, we selected visits that were enriched in number and scope of triggers. We calculated interrater reliability for each trigger and present proportions with CIs and present descriptive and univariate data for patient
Volume 70, no. 4s : October 2017